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Background: Postnatal care (PNC) knowledge and positive perceptions are crucial for women’s utilisation of PNC services. Aim: The study aimed to assess the level of PNC knowledge, perceptions of PNC, and determinants of both among women. Setting: Public healthcare facilities in the Oshana region, Namibia. Methods: The study followed a quantitative cross-sectional survey design. A self-administered questionnaire was administered to 814 participants selected via systematic random sampling. PNC knowledge and perceptions were used separately as dependent variables. Participants’ characteristics were used as independent variables. Chi-square tests and binomial and multinomial logistic regression were used to analyse associations between PNC knowledge or perceptions and participants’ characteristics. Results: Among the participants, 55.6% (n = 434) demonstrated good PNC knowledge, while 27.3% (n = 213) had positive PNC perceptions. Participants who had no formal education, were unemployed, and did not utilise PNC services had a lower likelihood of having good PNC knowledge; adjusted odds ratio (AOR) = 0.33, 95% confidence interval (CI), 0.21–0.53, crude odds ratio (COR) = 0.68, 95% CI, 0.49–0.92; and AOR = 0.72, 95% CI, 0.52–0.98. Similarly, women who did not attend antenatal care had a lower likelihood of having positive PNC perceptions; COR = 0.56, 95% CI, 0.33–0.96. Conclusion: There is a need for multipronged interventions to improve PNC knowledge and perceptions among women in the Oshana region. Contribution: This study identified context-specific factors that influence women’s PNC knowledge and perceptions.

Background: Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). Methods: We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. Results: We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. Conclusions: Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices.

Background: Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. This study assessed the one-month PrEP retention rate among AGYW 15–24 and the associated factors. Methods: The program’s target populations for PrEP included AGYW aged 15–24 years who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. Results: Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8–14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7–12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners’ HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1–2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15–1.43), and COR = 2.00, 95% CI (1.62–2.46), respectively. Conclusions: Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences.

The COVID-19 pandemic has wrought a profound impact on mental health in Sub- Saharan Africa, exacerbating existing disparities and rendering individuals undergoing treatment particularly susceptible. This comprehensive critical review delves into the scope, nature, and extent of COVID-19 impact on mental health services in Sub- Saharan Africa, while concurrently elucidating pivotal lessons and exemplary practices learnt from periods of lockdown. The methodology was guided by Jesson & Laccy's guide on how to conduct critical literature reviews. Articles were comprehensively sought through two academic databases (PubMed and Google Scholar), complemented by targeted searches on the WHO website and official public health websites of relevant Sub-Saharan African countries. The investigation reveals a surge in mental health challenges, notably marked by a significant escalation in anxiety, depression, and post-traumatic stress disorder. Disruptions to care services, financial hardships, and the pervasive effects of social isolation further compound this escalation. The pre-existing inequalities in access to and quality of care were accentuated during this crisis, with marginalized groups encountering heightened impediments to essential services. In navigating this unprecedented challenge, communities emerged as integral agents in establishing supportive networks and implementing culturally sensitive interventions. Technology, such as telemedicine and online resources, played a pivotal role in bridging access gaps, particularly in remote areas. The synthesis of best practices for supporting mental health patients during lockdowns encompasses targeted interventions for vulnerable groups, including adolescents and pregnant women. Empowering communities through economic support and mental health literacy programs was identified as crucial. The integration of technology, such as the development of robust telemedicine frameworks, virtual training in curricula, and the utilization of digital platforms for interventions and public messaging, emerged as a cornerstone in addressing access disparities. Community engagement and resilience-building strategies gained prominence, emphasizing the necessity of collaboration between healthcare providers and communities. Promotion of peer support groups, home-based care, and the preservation of traditional healing practices were underscored as essential components. The study underscores the need to adapt and optimize mental health services during emergencies. This entails prioritizing mental health within emergency response frameworks, exploring alternative service delivery methods, and fortifying data collection and research efforts. •COVID-19 impact on mental health service delivery is critically and comprehensively assessed.•Vulnerabilities of mental health care as discussed.•Inequitable access, and long-term consequences of COVID-19 on mental health emerged.•Addressing the digital divide hindering the adoption of alternative service delivery models was key.

Introduction The burden of HIV in sub‐Saharan Africa (SSA) remains unacceptably high, and disproportionately affects girls and women. While the introduction of oral HIV pre‐exposure prophylaxis (PrEP) in 2012 revolutionized HIV prevention, its effectiveness is dependent on user adherence and its implementation in SSA has faced numerous challenges. Patient‐level, interpersonal and structural barriers, including, for example, daily pill burden, side effects, lack of partner support, testing and disclosure, and costs have been found to reduce adherence to oral PrEP. Discussion Long‐acting extended delivery (LAED) formulations for PrEP, such as injectable long‐acting cabotegravir (CAB‐LA) and dapivirine vaginal ring (DPV‐VR) are critical additions to the HIV prevention toolkit and are especially important for populations such as adolescent girls and young women (AGYW) and other key populations who remain at significant risk of HIV acquisition while facing substantial barriers to preventive services. These LAED formulations have been shown to result in better adherence and fewer side effects, with CAB‐LA being superior to oral PrEP in reducing the risk of HIV acquisition. They can be used to overcome user burden and adherence challenges. However, the successful rollout of the DPV‐VR and CAB‐LA may be hampered by issues such as a shortage of healthcare providers (HCPs), inadequate parenteral medication infrastructure, increased workload for HCPs, patient concerns, the price of the medications and the possibility of drug resistance. Conclusions SSA must develop laboratory capabilities for monitoring patients on LAED formulations and enhance research on developing more non‐injectable LAED formulations. There is a need to train and retain more HCPs, implement task shifting, invest in healthcare infrastructure and integrate healthcare services. To reduce costs and improve availability, the region must advocate for patent license waivers for LAED formulations and procure drugs collectively as a region.

Background: Adolescent girls and young women (AGYW) who engage in alcohol and substance abuse face more significant health and social consequences compared to the general population. This study evaluated the prevalence and associated factors of alcohol abuse and substance use among AGYW in Namibia. Methods: We conducted a retrospective analysis of programmatic data from AGYW aged 10–24 who participated in the Determined, Resilient, Empowered AIDS-free, Mentored, and Safe (DREAMS) component of the Reducing HIV Vulnerability: Integrated Child and Youth Health (REACH) Project HOPE Namibia from March to December 2024. Data analysis was conducted employing chi-squared tests alongside binomial and multinomial logistic regression. Results: Among the 19,662 participants included in this analysis, 2068 (10.5%) abused alcohol and/or substances in the previous six months. Participants who were HIV-negative or did not know their status (AOR = 1.57, 95% CI (1.15–2.14), and AOR = 1.50, 95% CI (109–2.07), respectively), from outside Windhoek, those who had failed or repeated school in the previous year (COR = 1.77, 95% CI (1.54–2.05)), those not disabled (AOR = 1.27, 95% CI (1.06–1.52)), those who had dropped out of school or had completed their studies, and those with no adult emotional support (AOR = 1.25, 95% CI (1.11–1.40)), were more likely to have abused alcohol and/or substances recently. In contrast, participants who were not depressed were less likely to have recently abused alcohol and substances. Conclusions: The prioritization of strategies to identify AGYW experiencing depression and to provide them with treatment is essential. Moreover, it is important to encourage parents and guardians to provide emotional support to AGYW, as it prevents them from abusing alcohol and substances.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2019, only 81% of people living with HIV in SSA knew their HIV status, and only 68% of those diagnosed were on antiretroviral therapy (ART).2 Poor linkage to HIV care is a major barrier to achieving the UNAIDS 95-95-95 targets, which aim to diagnose 95% of people living with HIV, put 95% of those diagnosed on ART and achieve viral suppression in 95% of those on ART by 2030.3 In recent years, HIV self-testing (HIVST) has emerged as a promising strategy for expanding access to HIV testing services in SSA. Of all the participants who took part in a study in Nairobi, Kenya, among men who have sex with men to determine the factors associated with HIVST, it was revealed that 55.9% of them had used HIVST.9 A community-based prospective study conducted in Blantyre, Malawi, to determine the uptake, accuracy, safety and linkage into care revealed that 76.5% of the participants self-tested during a 12-month period.10 A demonstration project to determine the feasibility of community-based HIVST in Johannesburg, South Africa, revealed that 68.7% of the participants selected unsupervised HIVST.11 However, linkage to HIV care for those who test positive through HIVST remains a significant challenge.8 A study conducted in Malawi revealed that 56% of community-based self-testers who tested HIV positive were linked to HIV care.10 In Kenya, 50% of partners of pregnant and postpartum women who tested HIV positive using HIVST were linked to a confirmatory HIV test.12 In this paper, we discuss potential approaches for improving linkage to HIV care among individuals who test HIV positive after HIVST in SSA. [...]people living with HIV in rural areas may face significant barriers to accessing HIV care and treatment services. Studies have shown that effective linkage to HIV care is crucial for improving HIV treatment outcomes, reducing HIV transmission and improving the overall health of people living with HIV.18 Fragmented care services can prevent individuals from receiving timely and appropriate HIV care, leading to poorer health outcomes and increased risk of transmission.

Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections in the world in 2020 were in this region. Oral PrEP was found to be very effective in reducing the risk of HIV-1 transmission. However, its effectiveness is highly dependent on users adhering to the drugs. The availability of long-acting injectable PrEP that eliminates the need for a daily pill may increase PrEP uptake and adherence in people who struggle to adhere to oral PrEP. The USA's FDA approved long-acting cabotegravir (CAB-LA) for PrEP of HIV-1 in December 2021. In this review, we discussed the implementation challenges to the successful roll-out of CAB-LA in Africa and measures to address these implementation challenges. Some health system-level challenges include the cost of the drug, its refrigeration requirement, and the shortage of healthcare providers trained to administer parenteral medicines. In contrast, client challenges include lack of knowledge, accessibility of the drug, side effects, stigma, and lack of family and community support. These challenges can be addressed by several measures emanating from lessons learned from the successful implementation of ART, oral PrEP, and immunization in the continent. Some steps include advocating for waiving of CAB-LA patent licence, conducting demonstration projects in Africa, promoting the use of renewable energy sources such as solar energy, healthcare provider training, task shifting, community engagement, client education, and implementing adherence promotion strategies.

Background: Namibia is experiencing a generalized HIV epidemic, with 7.5% of the population living with HIV. Adolescent girls and young women (AGYW) aged 15–24 account for 28.6% of new infections annually. Various factors increase AGYW’s vulnerability to HIV. To address this, Project HOPE Namibia (PHN)-led consortium implemented the PEPFAR/USAID-funded DREAMS project in Khomas, Oshikoto, and Zambezi regions from 2018 to 2023. This study estimated the AGYW population most in need of HIV prevention and assessed geographic and age-specific gaps to improve program effectiveness and efficiency. Methods: This secondary data analysis utilized the Namibia Population-Based HIV Impact Assessment (NamPHIA) 2017, the Namibia census, and service data from the DREAMS project, which includes entry points for recruitment, screening, and enrolment. We used Python to conduct unadjusted and adjusted Poisson regression and UpSet plots for data visualization. Results: Analysis of NamPHIA data revealed low HIV prevalence in 10–14-year-olds, with only Oshikoto showing a detectable rate of 2.76%, mostly attributed to perinatal HIV transmission. Of the 12 DREAMS eligibility criteria, three could be mapped to 10–14-year-olds, while all except sexually transmitted infections could be mapped for 15–19 and 20–24-year-olds. Nationally, 17.3% of 10–14-year-old AGYW, 48.0% of 15–19-year-olds, and 50% of 20–24-year-olds met at least one DREAMS eligibility criterion. Among 15–19-year-olds, a history of pregnancy, no/irregular condom use, and out-of-school status were positively associated with HIV status. For 20–24-year-olds, transactional sex was positively associated with HIV status. Overall, 62% of screened individuals were eligible, and 62% of eligible individuals enrolled. PHN screened 134% of the estimated 37,965 10–14-year-olds, 95% of the estimated 35,585 15–19-year-olds, and 57% of the 24,011 20–24-year-olds residing in the five districts where DREAMS was implemented. Conclusions: We recommend the refinement of the DREAMS eligibility criteria, particularly for AGYW 10–14, to better identify and engage those at risk of HIV acquisition through sexual transmission. For 15–19-year-olds, PHN efforts should interrogate geographic variability in entry points for recruitment and screening practices. PHN should enhance the recruitment and engagement of AGYW 20–24, with a particular focus on those engaged in transactional sex.

This opinion paper dives into the crucial but challenging space of HIV prevention for adolescents and young persons (AYPs). While their vulnerabilities may be heightened, so too is their potential for resilience, innovation, and positive change. To safeguard their health and empower them to make informed choices, a comprehensive science-to-program and systems approach to HIV prevention is paramount. Recognizing their unique vulnerabilities and immense potential, these authors advocate for a multifaceted approach that bridges the gap between scientific evidence and program implementation within a robust healthcare system. This opinion unpacks how leadership, governance, health policies, human resources, health information systems, and HIV surveillance can be strengthened to create a supportive ecosystem where AYPs have the knowledge, resources, and services they need to thrive. This collective effort, involving policymakers, healthcare providers, educators, and AYPs themselves, is critical to a future where no young person is left behind in the fight against HIV.